Identifying the indications for laparoscopically assisted vaginal hysterectomy: a prospective, randomised comparison with abdominal hysterectomy in patients with symptomatic uterine fibroids

Objective To compare laparoscopically assisted vaginal hysterectomy (LAVH) and total abdominal hysterectomy (TAH) in patients with uterine fibroids. Design A prospective randomised study. Setting The San Paolo Hospital, Milan. Population Sixty-two patients, who were not suitable for a vaginal hysterectomy, requiring treatment for uterine fibroids. Methods Randomisation between LAVH and TAH. Comparison of outcomes on the whole series, patients with uteri less than or equal to 500 g (Group 1) and patients with uteri > 500 g (Group 2). Main outcome measures To establish operating time, blood loss, complications, febrile morbidity, analgesics administration and hospital stay for both treatment approaches. Results Median uterine weight was 400 g in both LAVH and TAH group. Median operating time was longer for LAVH (135 min compared with 120 min for TAH; P = 0.001), but patients undergoing LAVH had less analgesics administration (23% compared with 77%, P < 0.001) and a shorter median hospital stay (3.8 compared with 5.8 days; P < 0.001). LAVH, when compared with TAH in the two weight subgroups, required a significantly longer operating time only in Group 2, significantly reduced analgesics administration only in Group 1, and significantly reduced hospital stay in both groups. Conversions of LAVH to laparotomy were significantly more frequent in Group 2 (3/11) than in Group 1 (0/20) (P = 0.04). Conclusions Compared with TAH, LAVH has advantages in removing uteri weighing less than or equal to 500 g, with comparable operating time, less post-operative pain and shorter recovery. Among uteri weighing > 500 g LAVH showed a shorter recovery, but longer operating time than TAH and a 27% rate of conversion to laparotomy.